Breastfeeding and Drugs (Nursing)

00:01 Hi, welcome to our pharmacology video series.

00:03 In this one, we're gonna take a look at the impact of breastfeeding and medications.

00:08 Now, drug therapy during breastfeeding is a little tricky.

00:11 You know, obviously moms wanna be very cautious about what they take when they're breastfeeding.

00:16 Now, we don't have as much reliable data regarding toxicity from drug use during pregnancy or breastfeeding as we do with non-pregnant patients.

00:25 What we do have since 2009 is the Medication Exposure in Pregnancy Risk Evaluation Program.

00:32 So we're gathering more data but you can understand why this very vulnerable population, we are meticulous in keeping them safe while trying to collect data.

00:42 So first up, can I start this conversation without thinking about breast milk, right? Most drugs administered to lactating women are detectable in breast milk.

00:52 So let's say that right up front.

00:55 Most drugs administered to lactating women are detectable in breast milk but the concentration of the drugs in breast milk is usually low.

01:04 So that's the good news. Yes, you can detect it but it's usually low.

01:09 Now, we're gonna talk about some specific cases but that's the first concept I want you to have solid before we move on.

01:15 So for example, let's say that the mom was taking a Tylenol, the amount the infant would receive in the breast milk in a day is substantially less than what would likely be considered a therapeutic dose for the infant.

01:29 So that's just to give you a frame of reference.

01:31 That's not a rule of thumb you can use about everything but it's just to give you a frame of reference.

01:36 For most medications, it'll be detectable in breast milk but the concentration is usually very low.

01:43 Now, if the nursing mother has to take medications and the drug is a relatively safe one, here's what she should do.

01:49 Optimally, it would be great if she could take it 30-60 minutes after nursing and 3-4 hours before the next feeding.

01:58 So we're trying to kinda time medication, you can work with the health care provider, you can work with a lactation specialist, but try to take the medication 30-60 minutes after nursing and 3-4 hours before the baby's next feeding.

02:12 Now, be careful with sedative-hypnotics.

02:14 That's a different kind of carrier or lithium or tetracyclines.

02:18 Those have special caution with them.

02:21 So what are the things that we can do to minimize risk to breastfeeding infants? Well, drugs can excreted in breast milk. We've got that, right? And the effects can occur in the infant.

02:32 Now, we know for most drugs, it's a lower concentration but that doesn't mean that the baby won't be affected.

02:38 So what are the things that we can do? We talked about initially what kind of an overall guideline is but let's talk about some more rules to consider.

02:46 These are guidelines to help try to keep the baby the safest.

02:49 Where we talked, take the drugs immediately after breastfeeding.

02:54 That's good. Avoid drugs that have long half-lives.

02:58 These are drugs that will stay in your system longer.

03:01 Choose drugs that tend to be excluded from milk and that are the least likely to affect the infant, and avoid drugs that are known to be hazardous.

03:09 Okay, we could've labeled this slide 'common sense when breastfeeding', right? We already knew take things immediately after breastfeeding.

03:17 That's the best time to do it.

03:18 Avoid drugs that are gonna hang around for a long time, pick drugs that tend to be excluded from breast milk, and avoid drugs that are known to be hazardous.

03:27 Tada. Alright, common sense for breastfeeding mothers.